Distribution and seasonality of rhinovirus and other respiratory viruses in a cross-section of asthmatic children in Trinidad, WestIndies

BACKGROUND: Childhood asthma in the Caribbean is advancing in prevalence and morbidity. Though viral respiratory tract infections are reported triggers for exacerbations, information on these infections with asthma is sparse in Caribbean territories. We examined the distribution of respiratory viruses and their association with seasons in acute and stable asthmatic children in Trinidad. METHODS: In a cross-sectional study of 70 wheezing children attending the emergency department for nebulisation and 80 stable control subjects (2 to 16 yr of age) in the asthma clinic, nasal specimens were collected during the dry (n = 38, January to May) and rainy (n = 112, June to December) seasons. Amultitarget, sensitive, specific high-throughput Respiratory MultiCode assay tested for respiratory-virus sequences for eight distinct groups: human rhinovirus, respiratory syncytial virus, parainfluenza virus,influenza virus, metapneumovirus, adenovirus, coronavirus, and enterovirus. RESULTS: Wheezing children had a higher [c2 = 5.561, p = 0.018] prevalence of respiratory viruses compared with stabilized asthmatics (34.3% (24) versus (vs.) 17.5% (14)).... CONCLUSION: Emergent wheezing illnesses during childhood can be linked to infection with rhinovirus in Trinidad's tropical environment. Viral-induced exacerbations of asthma are independent of seasons in this tropical climate. Further clinical and virology investigations are recommended on the role of infections with the rhinovirus in Caribbean childhood wheeze.

Distribution and seasonality of rhinovirus and other respiratory viruses in a cross-section of asthmatic children in Trinidad, West Indies.

BACKGROUND: Childhood asthma in the Caribbean is advancing in prevalence and morbidity. Though viral respiratory tract infections are reported triggers for exacerbations, information on these infections with asthma is sparse in Caribbean territories. We examined the distribution of respiratory viruses and their association with seasons in acute and stable asthmatic children in Trinidad. METHODS: In a cross-sectional study of 70 wheezing children attending the emergency department for nebulisation and 80 stable control subjects (2 to 16 yr of age) in the asthma clinic, nasal specimens were collected during the dry (n=38, January to May) and rainy (n=112, June to December) seasons. A multitarget, sensitive, specific high-throughput Respiratory MultiCode assay tested for respiratory-virus sequences for eight distinct groups: human rhinovirus, respiratory syncytial virus, parainfluenza virus, influenza virus, metapneumovirus, adenovirus, coronavirus, and enterovirus. RESULTS: Wheezing children had a higher [chi square =5.561, p=0.018] prevalence of respiratory viruses compared with stabilized asthmatics (34.3 per cent (24) versus (vs.) 17.5 per cent (14)). Acute asthmatics were thrice as likely to be infected with a respiratory virus (OR = 2.5, 95 per cent CI = 1.2 - 5.3). The predominant pathogens detected in acute versus stable asthmatics were the rhinovirus (RV) (n=18, 25.7 per cent vs. n=7, 8.8 per cent; p=0.005), respiratory syncytial virus B (RSV B) (n=2, 2.9 per cent vs. n=4, 5.0 per cent), and enterovirus (n=1, 1.4 per cent vs. n=2, 2.5 per cent). Strong odds for rhinovirus infection were observed among nebulised children compared with stable asthmatics (p=0.005, OR = 3.6, 95 per cent CI = 1.4 - 9.3,). RV was prevalent throughout the year (Dry, n=6, 15.8 per cent; Rainy, n=19, 17.0 per cent) and without seasonal association [chi square =0.028, p=0.867]...

Pesticide regulation, utilization, and retailers' selling practices in Trinidad and Tobago, West Indies: current situation and needed changes

OBJECTIVE: To explore pesticide regulation in Trinidad and Tobago, and to ascertain pesticide utilization and retailers' selling practices on Trinidad, which is the larger of twin islands that constitute the republic of Trinidad and Tobago. METHODS: Between February and June 2005, agrochemical retailers in Trinidad were surveyed about the most frequently sold pesticides and their knowledge and practices of pesticide sale. The Poisons and Toxic Chemicals Control Board of the Ministry of Health informed on legislature. RESULTS: Of 107 actively trading licensed pesticide outlets, 97 participated (91 percent response rate) in the survey. Currently only 2.9 percent (21) of 720 registered products from four chemical classes are frequently utilized. Paraquat, methomyl, and alpha-cypermethrin (respective trade names are Gramoxone, Lannate, and Fastac) from World Health Organization (WHO) Hazard Classes I and II, and glyphosate isopropylamine (Swiper, Class U) are the most frequently purchased pesticides. Pet shops constitute 39.2 percent (38) of retail shops selling pesticides. No regulations guide pesticide sale to agriculturists, and children may purchase them. Inadequate human and technical resources render legislative controls ineffective and disciplinary action against offenders is weak. Extensive governmental resources are employed in legislative procedures and product approval for the very low, 2.9 percent utilization rate, negatively impacting on monitoring pesticide sales. The Poisons Information Centre (PIC) does not liaise with the Poisons and Toxic Chemicals Control Board or provide educational interventions for the community. As a result of this survey, it was possible to develop the first database to include the chemical, brand, and colloquial names of pesticides used in Trinidad and Tobago; WHO classification of approved pesticides; manufacturers; packaging; and antidotes and their availability for use by the Board and health professionals...

OBJETIVO: Analizar la regulación de los pesticidas en Trinidad y Tobago y verificar la utilización y las prácticas de venta minorista de pesticidas en Trinidad, la mayor de las dos islas que componen la República de Trinidad y Tobago. MÉTODOS: Entre febrero y junio de 2005 se realizó una encuesta a los vendedores minoristas de sustancias químicas de Trinidad sobre los pesticidas más frecuentemente vendidos, así como sobre sus conocimientos y las prácticas de venta de pesticidas. La Junta de Control de Venenos y Sustancias Tóxicas (JCVST) del Ministerio de Salud informó sobre la legislación vigente. RESULTADOS: De 107 tiendas autorizadas que comerciaban activamente con pesticidas, 97 participaron en este estudio (tasa de respuesta de 91 por ciento). Solo 21 (2,9 por ciento) de los 720 productos registrados de cuatro clases de sustancias se utilizan con frecuencia. Los productos paraquat, metomil y alfacipermetrina (cuyos nombres comerciales respectivos son Gramoxone, Lannate y Fastac) pertenecientes a las clases de riego I y II de la Organización Mundial de la Salud (OMS) y la isopropilamina de glifosato (Swiper, Clase U) son los pesticidas más frecuentemente adquiridos. Las tiendas de mascotas constituyen 39,2 por ciento (38 unidades) de las tiendas minoristas que participaron en el estudio. No hay regulaciones que normen la venta de pesticidas a los agricultores y los niños pueden comprarlos. Los recursos humanos y técnicos inadecuados hacen inefectivos los controles legislativos y las medidas disciplinarias contra los infractores son débiles. Se emplean considerables recursos gubernamentales en procedimientos legislativos y en la aprobación de productos de muy baja (2,9 por ciento) tasa de utilización, lo que afecta negativamente en el monitoreo de las ventas de pesticidas. El Centro de Información sobre Venenos no coordina sus acciones con la JCVST ni ofrece intervenciones educativas para la comunidad. Como resultado de este...

Pesticide regulation, utilization, and retailers' selling practices in Trinidad and Tobago, West Indies: current situation and needed changes.

OBJECTIVE: To explore pesticide regulation in Trinidad and Tobago, and to ascertain pesticide utilization and retailers' selling practices on Trinidad, which is the larger of twin islands that constitute the republic of Trinidad and Tobago. METHODS: Between February and June 2005, agrochemical retailers in Trinidad were surveyed about the most frequently sold pesticides and their knowledge and practices of pesticide sale. The Poisons and Toxic Chemicals Control Board of the Ministry of Health informed on legislature. RESULTS: Of 107 actively trading licensed pesticide outlets, 97 participated (91 per cent response rate) in the survey. Currently only 2.9 per cent (21) of 720 registered products from four chemical classes are frequently utilized. Paraquat, methomyl, and alpha-cypermethrin (respective trade names are Gramoxone, Lannate, and Fastac) from World Health Organization (WHO) Hazard Classes I and II, and glyphosate isopropylamine (Swiper, Class U) are the most frequently purchased pesticides. Pet shops constitute 39.2 per cent (38) of retail shops selling pesticides. No regulations guide pesticide sale to agriculturists, and children may purchase them. Inadequate human and technical resources render legislative controls ineffective and disciplinary action against offenders is weak. Extensive governmental resources are employed in legislative procedures and product approval for the very low, 2.9 per cent utilization rate, negatively impacting on monitoring pesticide sales. The Poisons Information Centre (PIC) does not liaise with the Poisons and Toxic Chemicals Control Board or provide educational interventions for the community. As a result of this survey, it was possible to develop the first database to include the chemical, brand, and colloquial names of pesticides used in Trinidad and Tobago;...

Pfcrt and pfmdr1 alleles associated with chloroquine resistancein plasmodium falciparum from Guyana, South America

Using DNA extracted from 112 parasitised blood blots, we screened for the population marker of chloroquine resistance (CQR) pfcrt K76T in Plasmodium falciparum infections from Guyana. Pfmdr1 mutations S1034C, N1042D, and D1246Y also associated with CQR were surveyed as well in 15 isolates for which the in vitro responses to CQ were known. Results indicate that the pfcrt K76T is ubiquitous in this environment, and confirmatory sequencing of codons 72 and 76 revealed two novel allelic sequences SVMIT and RVMNT in addition to the previously identified CVMNT and SVMNT haplotypes. The frequency of the pfcrt K76T despite its presence in both CQR and CQS (chloroquine sensitive) infections measured in vivo and in vitro, suggests that it is a useful population marker in this low-transmission setting of sweeping CQR.

Physician behaviour for antimicrobial prescribing for paediatricupper respiratory tract infections: a survey in general practice inTrinidad, West Indies.

Background: Upper respiratory tract infections (URTIs) are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored general practitioners' (GPs) prescribing behaviour for antimicrobials in children (¡Ü 16 years) with URTIs in Trinidad, using the guidelines from the Centers for Disease Control and Prevention (CDC) as a reference. Methods: A cross-sectional study was conducted on 92 consenting GPs from the 109 contacted in Central and East Trinidad, between January to June 2003. Using a pilot-tested questionnaire, GPs identified the 5 most frequent URTIs they see in office and reported on their antimicrobial prescribing practices for these URTIs to trained research students. Results: The 5 most frequent URTIs presenting in children in general practice, are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media (AOM) in rank order. GPs prescribe at least 25 different antibiotics for these URTIs with significant associations for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, erythromycin, clarithromycin and azithromycin (p < 0.001). Amoxicillin alone or with clavulanate was the most frequently prescribed antibiotic for all URTIs. Prescribing variations from the CDC recommendations were observed for all URTIs except for AOM (50 per cent), themost common condition for antibiotics. Doctors practicing for >30 years were more likely to prescribe antibiotics forthe common cold (p = 0.014). Severity (95.7 per cent) and duration of illness(82.5 per cent) influenced doctors' prescribing and over prescribing in general practice was attributed to parent demands (75 per cent) and concern for secondary bacterial infections (70 per cent). Physicians do not request laboratory investigations primarily because they are unnecessary (86 per cent) and the waiting time for results is too long (51 per cent).

Pfcrt and pfmdr1 alleles associated with chloroquine resistance in Plasmodium falciparum from Guyana, South America

Using DNA extracted from 112 parasitised blood blots, we screened for the population marker of chloroquine resistance (CQR) pfcrt K76T in Plasmodium falciparum infections from Guyana. Pfmdr1 mutations S1034C, N1042D, and D1246Y also associated with CQR were surveyed as well in 15 isolates for which the in vitro responses to CQ were known. Results indicate that the pfcrt K76T is ubiquitous in this environment, and confirmatory sequencing of codons 72 and 76 revealed two novel allelic sequences SVMIT and RVMNT in addition to the previously identified CVMNT and SVMNT haplotypes. The frequency of the pfcrt K76T despite its presence in both CQR and CQS (chloroquine sensitive) infections measured in vivo and in vitro, suggests that it is a useful population marker in this low-transmission setting of sweeping CQR.